OHP heal thyself

OH practitioners may be so involved in helping others they neglect
themselves and end up burnt out and exhausted. Tips on identifying the causes,
spotting the symptoms and dealing with the problem are offered, by Nerina
Ramlakhan

Working in occupational health is challenging and can even be frustrating at
times. This is particularly true in organisations that are struggling to learn
how to function effectively in an increasingly turbulent and unstructured
world.

As an organisational consultant and physiologist, I have spent a number of
years working at various levels within organisations, often liaising closely
with OH departments. I have witnessed a shift in the role of occupational
health and an impact on the health of the OH practitioner if the turbulence is
not navigated with care and attention to self. The aim of this article is to
raise awareness of what can cause burn-out and to highlight those strategies
that can help to prevent it.

What is burn-out?

Since Freudenberger’s1 pioneering work on burn-out among the caring
professions, there has been an explosion of interest in, and research about,
this particular syndrome. Burn-out has been described as "to fail, wear
out, or become exhausted by reason of excessive demands on energy, strength, or
resources". Maslach2 defined it as: "The loss of concern for the
people with whom one is working … (including) physical exhaustion … (and)
characterised by an emotional exhaustion in which the professional no longer
has any positive feelings, sympathy or respect for clients or patients".

The symptoms of burn-out are as varied as the sufferers. Some people become
irrationally angry. Some resort to blaming any annoyance, large or small, on
external factors. Some become quiet, introverted and isolated, which can
indicate the start of a serious depression. Others manifest burn-out by under-
or over-eating or abusing alcohol or other mood-altering substances. Still
others may experience a range of physical symptoms, including chronic illness,
high blood pressure and frequent headaches.

In my experience of working with OHPs who have come close to burning out or
are actually burnt out, they may become obsessive workaholics – working longer
and less productive hours to get the job done. Time management becomes reactive
and firefighting the norm at the expense of creative and visionary work.

Figuring out if you are stressed and on the verge of burn-out is not
difficult if you take the time to step back and evaluate your situation (see
box). The more difficult issue is often related to teasing apart the various
causes of burn-out and then trying to manage those that are controllable.

The work environment

The work environment has undergone profound changes in the past 30 years or
so, driven largely by information technology and global competitive demands. In
parallel, the image, perception and role of occupational health has changed,
and the terrorist events of 11 September served as a further catalyst for
raising issues about safety and wellness.

Clients’ needs have also changed and this has inevitably had a knock-on
effect on the role of occupational health and its practitioners. Says OH
consultant, Carol Cholerton: "OH has shifted from being a nice-to-have
benefit, to having to justify its existence to the business in very hard-nosed
terms."

This inevitably places additional responsibilities on OH practitioners to
acquire and develop marketing skills that will enable them to be heard by
management. In other words they need to be able to speak the language of
business. For many OH practitioners, frustrations arise when they feel they are
not being heard.

Are you susceptible? Personality and burn-out

Freudenberger1 identified three personality types in the caring professions
as being sensitive to burn-out:

– the dedicated and committed personality type

– the personality type that is overcommitted and whose private life is
unsatisfactory

– the authoritarian personality and/or patronising personality type.

No matter what the personality type, when external demands continue to
increase, self-imposed demands can create even more pressure, and compounding
this may be the insidious ego stroking involved in working harder. Although
anyone can experience excessive stress, in my experience of working with OH
departments, many practitioners do possess certain traits, which may be
reinforced in their training, that make them more susceptible to burn-out; they
are conscientious and committed and much of their personal identity may be tied
up with their professional identity.

Some people report that it is tough out there and getting tougher. However,
some people and some organisations are nonetheless thriving. Darwin’s idea is
that it is the fittest that shall survive, but he did not mean strongest –
which is the usual misapprehension. He meant those organisms that are most
adaptable to changing conditions. The following toolkit contains what I think
can help in these turbulent times. Many of these are things we all know and
recommend to our clients or patients but often neglect to follow ourselves. So,
a little reminder.

– Manage food stress – start the day with breakfast and then eat little and
often throughout the day, particularly if you are going to be working long
hours. Keep healthy snacks (nuts, fruit, bagels) with you and avoid going for
quick fixes such as caffeine or sweets. Try to drink at least one litre of
water a day.

– Create a healthy balance between activity and rest – research in
chronobiology suggests that we should take breaks every 60 to 90 minutes in
order to rejuvenate and replenish mental/physical energy. Take a break away from
your desk whenever possible, find a flight of stairs and walk up and down a few
times, go for a walk around the block, change mental channels for five to 10
minutes. If you cannot get away from your office, do some stretches at your
desk to release neck and shoulder tension, eye exercises to release tension, or
breathing exercises to lift your energy.

– Stay fit for the job – we have evolved as an active species and as such we
need physical activity to keep stress in balance. Try to engage in some form of
aerobic activity at least three times a week.

– Create healthy boundaries in your life – do you take a lunch break (even
20 minutes is enough to replenish your energy)? What time do you leave work? Do
you take work home, and if so, do you do it? Do you talk about work /think
about it constantly when you go home? Can you engage in something positive that
will help you to switch off? If you are going to talk about work, put a time
limit on it and do not allow it to ambush your whole evening.

– Optimise sleep – this means keeping work out of your bedroom, allowing
yourself time to wind down in the evenings (even if this means going to bed
later), minimising caffeine, alcohol and other stimulants and using relaxing
essential oils such as lavender in your bath or on your pillow. Try to let go
of anxieties about how much or how little sleep you should be getting as this
just compounds insomnia. If you wake up at night and cannot get back to sleep,
try getting up and writing about what may be bothering you. If you have a
tendency to wake up with your ‘to do’ list going round and round in your head,
try writing lists before you leave work.

The emotional toolkit

In the wake of the tragic events of 11 September, I have become more aware
of the way in which the current world conditions and emotional climate can
impact upon individuals. Increasingly, we need to develop and hone our sense of
emotional balance. This means becoming aware of when we are carrying around
negative emotions and losing balance.

– Awareness – get into the habit of regularly doing an emotional check,
particularly if you have just been ‘counselling’ a client. Are you holding any
tension in your body? Can you release it by stretching or using breathing
techniques? Use your journey home (even if standing on a packed commuter train)
to do an emotional check and relax your body. The key to doing this is by
breathing slowly and deeply from your diaphragm and bringing your mind into
present focus.

– Keep a journal – avoid bottling things up. Getting your feelings out on to
paper can be an effective way of letting off steam and making sense of things.

– Support – one of the most therapeutic things you can do for yourself and
others is to form a support network with other OHPs. This should not amount to
a group of people sitting around complaining, but a forum for sharing problems
and seeking solutions. Talk to friends and family and be selective about who
will give you a genuine listening ear and help you to find constructive
solutions.

– Join a yoga or pilates class – breathing techniques are very effective for
releasing negative emotions such as anger and fear as they arise.

– Honesty – this is about truly acknowledging how you feel about a
situation. Often, when we become emotionally overwhelmed by a situation or
problem our knee-jerk response is to run away from confronting it by engaging
in manic ‘hyper-productivity’. We may be keeping ourselves busy but not
actually getting much done and the mind is continuously running by itself with
no guidance or direction. The key is to stop, clear space to focus mentally and
deal with your feelings constructively, even if it means having a good cry.

The marketing toolkit

Marketing is important for the OHP who is frustrated by an unresponsive
organisation. This is about what the client wants, not what the OHP wants.

If no-one is listening, why? Are you listening to the client? Are you giving
them solutions that can be used?

This is not about lack of vision or ethics, or even pandering to clients.
This is about listening to clients, becoming aware of their problems and then
considering how this relates to your business. As one OHP put it: "It’s
about thinking out of the OH box into the business they are operating in."

Find your supporters

The dreaded word ‘networking’. Who is on your side? Who will listen to, and
support you? Take every opportunity to liaise with your clients and get to know
the business.

Speak the right language

Communicate in such a way that will achieve buy-in. Can you communicate effectively
in meetings? Can you chair meetings? Can you use the language that the business
can relate to?

OH professionals increasingly need to enable themselves and empower others
to survive these turbulent, unpredictable conditions and transform them into opportunities
for survival, if not growth. This means being totally committed to self-care
and achieving balance – whether in the clinic or the boardroom. High
performance depends as much on how much you renew and recover energy as on how
you expend it. When people feel strong and resilient – physically, mentally,
emotionally, and spiritually – they perform better, with more passion, for
longer. They win, their families win, and the organisations that employ them
win.

Nerina Ramlakhan, PhD is an organisational consultant and physiologist. She
runs a company called Equilibrium Solutions.

Assess your risk for burn-out

There are two types of stress – eustress and distress. Eustress, or positive
stress, occurs when you control your stress effectively. Distress, or negative
stress, occurs when stress controls you.

The following is a simple test to
help you to assess your predisposition to distress in your life. The more
questions with a ‘yes’ response, the greater your risk for burn-out.

– Are you highly achievement-oriented?

– Do you tend to withdraw from offers of support?

– Do you avoid discussing problems with others?

– Do you have difficulty delegating responsibilities to others,
including patients or clients?

– Do you prefer to work alone?

– Do you externalise blame?

– Are your relationships asymetrical; ie are you always giving?

– Is your personal identity bound up with your work role or
professional identity?

– Do you have a difficult time saying no?

– Is there a lack of opportunity for positive feedback outside
of your professional or work role?

– Do you live by the laws ‘don’t talk, don’t trust, don’t feel’?

Case study

Anna is a good example of a dedicated and committed OHP. She strives to work
harder to meet the increasing demands made on her. She feels unable to
question, nor effectively protest the right of clients or management to make
such escalating demands. She is a nurse of deep conviction and cannot say no
because of a basic belief system that the needs of others are worthwhile, while
hers are not.

When her efforts meet with less and less success, she works even harder.
Despite her decreasing cost-effectiveness, she continues to believe that with
longer hours and greater intensity she can make a genuine difference to the
organisation she is working for.

Breaking the cycle of burn-out came about when Anna was transferred to a
different team with an experienced and observant OH manager. Her manager, aware
of the dangers of Anna working from a deficit position (I’m not good enough),
soon intervened and worked with Anna on establishing some healthy boundaries –
a more balanced ratio of client-contact time to administrative time, healthier
working hours and breaks during the day, a holiday, and a communication skills
course. Anna was willing to contract for these changes with her manager in
order to break the cycle.